Healthcare Provider Details

I. General information

NPI: 1992823785
Provider Name (Legal Business Name): SHELTON HSU D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 09/07/2021
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26700 TOWNE CENTRE DR STE 270
FOOTHILL RANCH CA
92610-2844
US

IV. Provider business mailing address

PO BOX 2672
MISSION VIEJO CA
92690-0672
US

V. Phone/Fax

Practice location:
  • Phone: 949-668-0686
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number47266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: